المؤلفون: Sanjeev Kumar, Prashant Bajpai, Collin Joyce, Sushil Kumar Kabra, Rakesh Lodha, Dennis R. Burton, Bryan Briney, Kalpana Luthra

المصدر: Frontiers in Immunology, Vol 15 (2024)

مصطلحات موضوعية: HIV-1, children, elite-neutralizers, B cell repertoire sequencing, bnAbs, clonotypes, Immunologic diseases. Allergy, RC581-607

الوصف: IntroductionA limited subset of HIV-1 infected adult individuals typically after at least 2-3 years of chronic infection, develop broadly neutralizing antibodies (bnAbs), suggesting that highly conserved neutralizing epitopes on the HIV-1 envelope glycoprotein are difficult for B cell receptors to effectively target, during natural infection. Recent studies have shown the evolution of bnAbs in HIV-1 infected infants.MethodsWe used bulk BCR sequencing (BCR-seq) to profile the B cell receptors from longitudinal samples (3 time points) collected from a rare pair of antiretroviralnaïve, HIV-1 infected pediatric monozygotic twins (AIIMS_329 and AIIMS_330) who displayed elite plasma neutralizing activity against HIV-1.ResultsBCR-seq of both twins revealed convergent antibody characteristics including V-gene use, CDRH3 lengths and somatic hypermutation (SHM). Further, antibody clonotypes with genetic features similar to highly potent bnAbs isolated from adults showed ongoing development in donor AIIMS_330 but not in AIIMS_329, corroborating our earlier findings based on plasma bnAbs responses. An increase in SHM was observed in sequences of the IgA isotype from AIIMS_330.DiscussionThis study suggests that children living with chronic HIV-1 can develop clonotypes of HIV-1 bnAbs against multiple envelope epitopes similar to those isolated from adults, highlighting that such B cells could be steered to elicit bnAbs responses through vaccines aimed to induce bnAbs against HIV-1 in a broad range of people including children.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fimmu.2024.1272493/fullTest; https://doaj.org/toc/1664-3224Test

الوصول الحر: https://doaj.org/article/552993de7ea34eec9f11e58289329825Test

المؤلفون: Dinesh Kumar, Varun Goel, Suneeta Meena, Purva Mathur, Sushil Kumar Kabra, Rakesh Lodha, Sarman Singh

المصدر: Journal of Laboratory Physicians, Vol 15, Iss 03, Pp 443-449 (2023)

مصطلحات موضوعية: CD4 count, Cryptosporidium, Cyclospora, Cystoisospora, HIV/AIDS, Medicine

الوصف: Background Human microsporidiosis presents as an important and rapidly emerging opportunistic infection. However, the exact burden of this infection especially in the pediatric population of Northern India remains unknown. In this study, we investigated the prevalence of microsporidia among human immunodeficiency virus (HIV)-positive and HIV-negative pediatric patients who presented with diarrhea.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/0974-2727Test; https://doaj.org/toc/0974-7826Test

الوصول الحر: https://doaj.org/article/fcf8cca0fe414a2aae6a9be6f3475010Test

المؤلفون: Ashoo Grover, Balram Bhargava, Saumya Srivastava, Lokesh Kumar Sharma, Jerin Jose Cherian, Nikhil Tandon, Sudha Chandershekhar, Roderico H. Ofrin, Henk Bekedam, Deepika Pandhi, Aparna Mukherjee, Rupinder Singh Dhaliwal, Manjula Singh, Kavitha Rajshekhar, Sudipto Roy, Reeta Rasaily, Deepika Saraf, Dhiraj Kumar, Neeraj Parmar, Sushil Kumar Kabra, Dhruva Chaudhry, Ashok Deorari, Radhika Tandon, Rajdeep Singh, Binod Khaitan, Sandeep Agrawala, Sudeep Gupta, Satish Chandra Goel, Anil Bhansali, Usha Dutta, Tulika Seth, Neeta Singh, Shally Awasthi, Amlesh Seth, Jeyaraj Pandian, Vivekanand Jha, Sudhanshu Kumar Dwivedi, Reva Tripathi, Alok Thakar, Surinder Jindal, Banglore Nanjudaiah Gangadhar, Anjali Bajaj, Mohan Kant, Aniket Chatterjee

المصدر: Frontiers in Public Health, Vol 11 (2023)

مصطلحات موضوعية: Standard Treatment Workflows (STWs), universal health coverage (UHC), quality health care (QHC), public health, disease, Public aspects of medicine, RA1-1270

الوصف: Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80–90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1178160/fullTest; https://doaj.org/toc/2296-2565Test

الوصول الحر: https://doaj.org/article/17bf83c1cc9646d7b63122d987479a87Test

المؤلفون: Raj Kumar, Parul Mrigpuri, Rohit Sarin, Jitender Kumar Saini, Rashmi Yadav, Aditya Nagori, Sushil Kumar Kabra, Arpana Mukherjee, Geetika Yadav

المصدر: Monaldi Archives for Chest Disease (2023)

مصطلحات موضوعية: Environment, human health, short term consequences, Medicine

الوصف: Environmental pollution has harmful effects on human health, particularly the respiratory system. We aimed to study the impact of daily ambient air pollution on daily emergency room visits for acute respiratory symptoms. This study was conducted in two tertiary respiratory care centres in Delhi, India. Daily counts of emergency room visits were collected. All patients attending the emergency room were screened for acute onset (less than 2 weeks) of respiratory symptoms and were recruited if they were staying in Delhi continuously for at least 4 weeks and having onset (≤2 weeks) of respiratory symptoms. Daily average air pollution data for the study period was obtained from four continuous ambient air quality monitoring stations. A total of 61,285 patients were screened and 11,424 were enrolled from June 2017 to February 2019. Cough and difficulty in breathing were most common respiratory symptoms. Poor air quality was observed during the months of October to December. Emergency room visits with acute respiratory symptoms significantly increased per standard deviation increase in PM10 from lag days 2-7. Increase in wheezing was primarily seen with increase in NO2. Pollutant levels have effect on acute respiratory symptoms and thus influence emergency room visits. *************************************************************** *Appendix Authors list Kamal Singhal1, Kana Ram Jat2, Karan Madan3, Mohan P George4, Kalaivani Mani5, Randeep Guleria3, Ravindra Mohan Pandey5, Rupinder Singh Dhaliwal6, Rakesh Lodha2, Varinder Singh1 1Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India 2Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India 3Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India 4Department of Environment, Delhi Pollution Control Committee, Kashmere Gate, New Delhi, India 5Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India 6Department of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India

وصف الملف: electronic resource

العلاقة: https://www.monaldi-archives.org/index.php/macd/article/view/2511Test; https://doaj.org/toc/1122-0643Test; https://doaj.org/toc/2532-5264Test

الوصول الحر: https://doaj.org/article/63051822164c4457bcffb99cc6efa8b6Test

المؤلفون: Kiran Kumar Banothu, DM, Jhuma Sankar, MD, U. Vijaya Kumar, DM, Priyanka Gupta, MD, Mona Pathak, PhD, Kana Ram Jat, MD, Sushil Kumar Kabra, MD, Rakesh Lodha, MD

المصدر: Critical Care Explorations, Vol 5, Iss 1, p e0815 (2023)

مصطلحات موضوعية: Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: OBJECTIVES:. Our objective was to compare norepinephrine plus dobutamine versus epinephrine as the first-line agent in children with fluid refractory cold septic shock. DESIGN:. Open-label randomized controlled study. SETTING:. A single-center PICU from North India. PATIENTS:. Children 2 months to less than 18 years old with fluid refractory cold septic shock. INTERVENTIONS:. In the intervention group, norepinephrine and dobutamine were started and in the control group, epinephrine was started as the first-line vasoactive agent. The primary outcome was the proportion attaining shock resolution (attaining all the therapeutic endpoints) at 1 hour of therapy. MEASUREMENTS AND MAIN RESULTS:. We enrolled 67 children: 34 in the norepinephrine plus dobutamine group (intervention) and 33 in the epinephrine group (control). There was no difference in shock resolution at 1 hour (17.6% vs 9%; risk ratio [RR], 2.0; 95% CI, 0.54–7.35; p = 0.25), 6 hours (76.4% vs 54.5%; RR, 1.69; 95% CI, 0.92–3.13; p = 0.06), and 24 hours between the intervention and control groups, respectively. Children in the norepinephrine plus dobutamine group attained shock resolution earlier (measured from starting of vasoactive agents to attaining all the therapeutic endpoints) (hazard ratio, 1.84 [1.1–3.08]). The difference in 28-day mortality was not significant (23.5% vs 39.3% in the intervention and control groups, respectively [RR, 0.59; 95% CI, 0.28–1.25]). CONCLUSIONS:. In children with fluid refractory cold septic shock, with use of norepinephrine plus dobutamine as first-line agents, the difference in the proportion of children attaining shock resolution at 1 hour between the groups was inconclusive. However, the time to shock resolution was earlier in the norepinephrine plus dobutamine group. Also, fewer children in the intervention group were refractory to treatment. Further studies powered to detect (or exclude) an important difference would be required to test this intervention.

وصف الملف: electronic resource

العلاقة: http://journals.lww.com/10.1097/CCE.0000000000000815Test; https://doaj.org/toc/2639-8028Test

الوصول الحر: https://doaj.org/article/12a12d6174dd40b19e3c9d6c0446d6faTest

المؤلفون: Nitesh Mishra, Shaifali Sharma, Ayushman Dobhal, Sanjeev Kumar, Himanshi Chawla, Ravinder Singh, Muzamil Ashraf Makhdoomi, Bimal Kumar Das, Rakesh Lodha, Sushil Kumar Kabra, Kalpana Luthra

المصدر: Nature Communications, Vol 11, Iss 1, Pp 1-11 (2020)

مصطلحات موضوعية: Science

الوصف: Some infants develop broadly neutralizing antibodies (bnAbs) to HIV in a shorter time frame than adults, but the reasons aren’t well understood. Here, the authors study a cohort of 51 HIV-1 clade C perinatally infected infants of Indian origin and find that multivariant infection is associated with bnAbs in elite neutralizers.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2041-1723Test

الوصول الحر: https://doaj.org/article/0dc11c97dcc845ddb653c4c07121885eTest

المؤلفون: Kritika Setlur, Gargi Das, Aditya Gupta, Shivam Bansal, Sushil Kumar Kabra, Rachna Seth

المصدر: Pediatric Hematology Oncology Journal, Vol 7, Iss 4, Pp S28- (2022)

مصطلحات موضوعية: Pediatrics, RJ1-570

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2468124522003382Test; https://doaj.org/toc/2468-1245Test

الوصول الحر: https://doaj.org/article/909ee03293da479898a20474b6589490Test

المؤلفون: Devika Gupta, Deepshi Thakral, Sameer Bakhshi, Sushil Kumar Kabra, Dipendra Kumar Mitra

المصدر: Indian Journal of Pathology and Microbiology, Vol 62, Iss 2, Pp 279-282 (2019)

مصطلحات موضوعية: Griscelli syndrome, Hemophagocytic lymphohistiocytosis, Hematopoietic stem cell transplant, RAB27A gene, Pathology, RB1-214, Microbiology, QR1-502

الوصف: Griscelli syndrome is a rare autosomal recessive inherited disorder characterized by hypopigmentation, silver colored hair, and associated immunological deficiency, which proves fatal in the absence of timely intervention. Our patients diagnosed with Griscelli syndrome-2 presented with fever, hepatosplenomegaly, and deranged hematological and biochemical parameters. Both cases underwent detailed investigations comprising of hair mount microscopic examination, degranulation assay, and mutational studies. Our cases showed defective degranulation activity by NK cells and gene mutation analysis revealed RAB27A mutation that causes defect of cytotoxic granule exocytosis from natural killer (NK) and T-cells, manifesting clinically as hemophagocytic lymphohistiocytosis (HLH). Hematopoietic stem cell transplantation in one of the patients resulted in stable chimerism; however, the second case relapsed within a month after SCT. Stem cell transplantation is the only curative therapeutic option for GS2; thus, improvement in posttransplantation management may reduce mortality and posttransplant complications. Hence, any child who presents with partial albinism and clinical features suggestive of HLH, a peripheral blood, hair shaft mount examination along with basic immunological NK and T-cell cytotoxicity assay by flow cytometry will help clinch the diagnosis early. It can subsequently be confirmed by molecular study. Timely therapeutic intervention can prevent relapses and severe infection and improve outcome in these cases.

وصف الملف: electronic resource

العلاقة: http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2019;volume=62;issue=2;spage=279;epage=282;aulast=GuptaTest; https://doaj.org/toc/0377-4929Test

الوصول الحر: https://doaj.org/article/8ced02b54eec4a948496cf5b87f8c55dTest

المؤلفون: Animesh Ray, Mohit Chowdhury, Janya Sachdev, Prayas Sethi, Ved Prakash Meena, Gagandeep Singh, Immaculata Xess, Surabhi Vyas, Maroof Ahmad Khan, Sanjeev Sinha, David W. Denning, Naveet Wig, Sushil Kumar Kabra

المصدر: Journal of Fungi, Vol 8, Iss 4, p 400 (2022)

مصطلحات موضوعية: chronic pulmonary aspergillosis, aspergillosis, LDBio LFA, IgG, Aspergillus, post-tuberculosis, Biology (General), QH301-705.5

الوصف: Background: The diagnosis of CPA relies on the detection of the IgG Aspergillus antibody, which is not freely available, especially in resource-poor settings. Point-of-care tests like LDBio Aspergillus ICT lateral flow assay, evaluated in only a few studies, have shown promising results for the diagnosis of CPA. However, no study has compared the diagnostic performances of LDBio LFA in setting of tuberculosis endemic countries and have compared it with that of IgG Aspergillus. Objectives: This study aimed to evaluate the diagnostic performances of LDBio LFA in CPA and compare it with existing the diagnostic algorithm utilising ImmunoCAP IgG Aspergillus. Methods: Serial patients presenting with respiratory symptoms (cough, haemoptysis, fever, etc.) for >4 weeks were screened for eligibility. Relevant investigations, including direct microscopy and culture of respiratory secretions, IgG Aspergillus, chest imaging, etc., were done according to existing algorithm. Serums of all patients were tested by LDBio LFA and IgG Aspergillus (ImmunoCAP Asp IgG) and their diagnostic performances were compared. Results: A total of 174 patients were included in the study with ~66.7% patients having past history of tuberculosis. A diagnosis of CPA was made in 74 (42.5%) of patients. The estimated sensitivity and specificity of LDBio LFA was 67.6% (95% CI: 55.7–78%) and 81% (95% CI: 71.9–88.2%), respectively, which increased to 73.3% (95% CI: 60.3–83.9%) and 83.9% (95% CI: 71.7–92.4%), respectively, in patients with a past history of tuberculosis. The sensitivity and specificity of IgG Aspergillus was 82.4% (95% CI: 71.8–90.3%) and 82% (95% CI: 73.1–89%); 86.7% (95% CI: 75.4–94.1%) and 80.4% (95% CI: 67.6–89.8%), in the whole group and those with past history of tuberculosis, respectively. Conclusions: LDBio LFA is a point-of-care test with reasonable sensitivity and specificity. However, further tests may have to be done to rule-in or rule-out the diagnosis of CPA in the appropriate setting.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2309-608X/8/4/400Test; https://doaj.org/toc/2309-608XTest

الوصول الحر: https://doaj.org/article/79e6312e6a1244f3b636fd784b8a57fcTest

المؤلفون: Kana Ram Jat, Sushil Kumar Kabra, Aparna Mukherjee, Shivani Randev, Guruprasad R Medigeshi, Arti Kapil, Rakesh Lodha

المصدر: BMJ Open Respiratory Research, Vol 7, Iss 1 (2020)

مصطلحات موضوعية: Medicine, Diseases of the respiratory system, RC705-779

الوصف: IntroductionAcute respiratory infections (ARIs) in infancy may have a long-term impact on the developing respiratory system. We planned a prospective cohort study to determine the impact of ARI during infancy on the pulmonary function test indices at 3 years of age.MethodsA cohort of normal, full-term newborns were followed up 6 monthly and during ARI episodes. Infant pulmonary function tests (IPFTs) were performed at baseline and each follow-up visit using tidal breathing flow-volume loop, rapid thoracoabdominal compression (RTC) and raised volume RTC manoeuvres. During each ARI episode, nasopharyngeal aspirates were tested for respiratory pathogens by real-time PCR.ResultsWe screened 3421 neonates; 310 were enrolled; IPFT was performed in 225 (boys: 125 (55.6%)) at 3 years. During infancy, 470 ARI episodes were documented in 173 infants. At 3 years, children with history of any ARI episode during infancy had lower forced expiratory volume in 1 s (FEV1.0), forced expiratory volume in 0.75 s (FEV0.75), forced expiratory volume in 0.5 s (FEV0.5), forced expiratory flow between 25% and 75% of FVC (FEF25–75), and maximal expiratory flow at 25% of FVC (MEF25) as compared with those without any ARI episode during infancy. The ratio of tidal expiratory flow (TEF) at 25% or 50% of tidal expiratory volume to peak TEF (TEF50 or TEF25/peak TEF) at 3 years was significantly increased in children who had ARI in infancy.ConclusionsARI during infancy is associated with impaired pulmonary function indices such as increased resistance and decreased forced expiratory flow and volume at 3 years of age.

وصف الملف: electronic resource

العلاقة: https://bmjopenrespres.bmj.com/content/7/1/e000436.fullTest; https://doaj.org/toc/2052-4439Test

الوصول الحر: https://doaj.org/article/83abdbc59c264752a0077e31c5813b09Test